Boumis Evangelo, Capone Alessandro, Galati Vincenzo, Venditti Carolina, Petrosillo Nicola
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy.
BMC Infect Dis. 2018 Feb 1;18(1):65. doi: 10.1186/s12879-018-2956-5.
In the last decades, probiotics have been widely used as food supplements because of their putative beneficial health effects. They are generally considered safe but rare reports of serious infections caused by bacteria included in the definition of probiotics raise concerns on their potential pathogenic role in patients with particular predisposing factors. Patients with hereditary hemorrhagic telangiectasia (HHT) are exposed to infections because of telangiectasias and arteriovenous malformations (AVMs). We describe what is, to our knowledge, the first case of infective endocarditis (IE) caused by Lactobacillus rhamnosus in a patient with HHT. A systematic review of the relevant medical literature is presented.
A patient with HHT and an aortic bioprosthesis was admitted because of prolonged fever not responding to antibiotics. The patient had a history of repeated serious infections with hospitalizations and prolonged use of antibiotics, and used to assume large amounts of different commercial products containing probiotics. Weeks before the onset of symptoms the patient had been treated with nasal packings and with surgical closure of a nasal bleeding site because of recurrent epistaxis. A diagnosis of IE of the aortic bioprosthesis was made. All blood coltures were positive for L. rhamnosus. The patients responded to a cycle of 6 weeks of amoxicillin/clavulanate plus gentamicin. A systematic review of IE linked to consumption of probiotics, and of infective endocarditis in patients with HHT was conducted. 10 cases of IE linked to probiotics consumption and 6 cases of IE in patients with HHT were found.
Consumption of probiotics can pose a risk of serious infections in patients with particular predisposing factors. Patients with HHT can be considered at risk because of their predisposition to infections. Prophylaxis with antibiotics before nasal packings in patients with HHT can be considered.
在过去几十年中，益生菌因其假定的有益健康作用而被广泛用作食品补充剂。它们通常被认为是安全的，但关于益生菌定义中所包含的细菌引起严重感染的罕见报告引发了人们对其在具有特定易感因素患者中潜在致病作用的担忧。遗传性出血性毛细血管扩张症（HHT）患者由于毛细血管扩张和动静脉畸形（AVM）而容易受到感染。据我们所知，我们描述了首例由鼠李糖乳杆菌引起的HHT患者感染性心内膜炎（IE）。本文还对相关医学文献进行了系统综述。
一名患有HHT且植入主动脉生物假体的患者因抗生素治疗无效的长期发热入院。该患者有反复严重感染并住院以及长期使用抗生素的病史，且曾大量服用不同的含益生菌商业产品。在症状出现前几周，患者因反复鼻出血接受了鼻腔填塞和鼻出血部位的手术封闭治疗。诊断为主动脉生物假体的IE。所有血培养均显示鼠李糖乳杆菌阳性。患者对阿莫西林/克拉维酸加庆大霉素6周的疗程有反应。我们对与食用益生菌相关的IE以及HHT患者的感染性心内膜炎进行了系统综述。发现了10例与食用益生菌相关的IE病例和6例HHT患者的IE病例。
食用益生菌可能会给具有特定易感因素的患者带来严重感染的风险。HHT患者因其易感染的倾向可被视为有风险人群。对于HHT患者，在进行鼻腔填塞前可考虑使用抗生素进行预防。
